title: Airway management before chemoradiation for advanced head and neck cancer.
abstract: BACKGROUND
  Patients with upper aerodigestive tract tumors can have development of airway compromise both before and during chemoradiotherapy (CRT). Tracheotomy is the classic method for securing a safe airway, but tumor debulking may also be used.
  
  
  METHODS
  This was a retrospective review of locoregionally advanced tumors of the base of tongue, larynx, or hypopharynx undergoing CRT between 1995 and 2007.
  
  
  RESULTS
  Forty-two of the 109 patients presented with signs or symptoms of airway obstruction. Of these, 28 underwent tracheotomy before CRT, and 11 had tumor debulking. Two of the 11 patients who underwent debulking required tracheotomy within 1 year after CRT for persistent edema and fibrosis. Larynx tumors were more likely to require tracheotomy or debulking than other tumors (p = .01).
  
  
  CONCLUSIONS
  Debulking is a safe and effective alternative to tracheotomy in select patients with tumor-related airway obstruction before CRT. Patients who undergo debulking should be monitored closely for recurrence of airway compromise during and after CRT.
authors.affiliation: Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Langerman
authors.forename: Riddhi M
authors.initials: RM
authors.lastname: Patel
authors.forename: Ezra E W
authors.initials: EE
authors.lastname: Cohen
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Blair
authors.forename: Kerstin M
authors.initials: KM
authors.lastname: Stenson
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000601:surgery*; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000628:therapy*; D007822:Laryngeal Neoplasms / Q000628:therapy*; D008297:Male; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D059525:Supraglottitis / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014062:Tongue Neoplasms / Q000628:therapy*; D014140:Tracheotomy